Is active surveillance the best treatment for low-risk prostate cancer?

The authors aimed to determine whether patients developed unfavorable disease features while under active surveillance. 

Active surveillance involves no treatment. It involves close monitoring of prostate cancer patients to determine any sign of progression. It is currently recommended in low/intermediate risk prostate cancer cases instead of immediate treatment. Treatment is then offered if the cancer progresses.

Focal therapy involves active treatment that destroys prostate cancer tissue. Hemiablation is a form of focal therapy that targets an entire half of the prostate, regardless of how much cacer is present. Patients suitable for hemiablation therapy can be determined by unfavorable disease features which can include the percentage of cancer present in a sample and what Gleason score (rates how different cancer cells look when compared to normal cells on a scale of 2-10)  a patient has.

The aim of this study was to determine whether unfavorable disease features developed in the absence of active treatment.

157 prostate cancer patients with unilateral involvement of the prostate (only affecting one side) were analysed. The average age was 67 years. Out of 157 patients, 70 % had a single, positive biopsy and 50% had more than one repeat biopsy.

The risk of developing unfavorable disease features (UDF) over 3-5 years varied from 9-67% while under active surveillance.  Patients with >20 % of cancer in a single tissue sample (UDF 1) had a 3-year risk of 42% and a 5-year risk of 50%. Patients with >50% of cancer in a single tissue sample (UDF 2) had a 3-year risk of 9% and a 5-year risk of 11%. Patients with a Gleason pattern of 4 (cells are quite abnormal compared to healthy cellc) (UDF 3) had a 3-year risk of 10% and a 5-year risk of 20%. Patients with >20% of cancer in a sample and Gleason pattern of 4 (UDF 4) had a 3-year risk of 45% and a 5-year risk of 62%. Patients with >50% of cancer in a sample and Gleason pattern of 4 (UDF 5) had a 3-year risk of 15% and a 5-year risk of 21%.

Assuming the patients would receive hemiablation following diagnosis, their risk of developing unfavorable disease features were estimated as follows: Patients with UDF 1 had a 3-year and 5-year risk of 12%. Patients with UDF 2 had a 3-year and 5-year risk of 1%. Patients with UDF 3 had a 3-year risk of 5% and a 5-year risk of 7%. Patients with UDF4 had a 3-year risk of 15% and a 5-year risk of 17%. Patients with UDF5 had a 3-year risk of 5% and a 5-year risk of 7%. 

The majority of patients with low risk prostate cancer did not develop any unfavorable disease features while on active surveillance or during follow-up and did not require hemiablation therapy. 

Definition of disease progression differs between experiments so results cannot be widely applied. 

If you are currently under active surveillance and considering future treatments please consult your doctor.